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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, January 4, 2016

US + Alteplase for PE

Resultado de imagen de PulmCrit (Em crit)
PulmCrit- January 4, 2016 by Josh Farkas
"Ultrasound-assisted catheter-directed thrombolysis is increasingly popular for submassive PE. This involves placement of a catheter into one or both pulmonary arteries which infuses alteplase and also vibrates ultrasonically. The combination of localized alteplase and vibrational energy is intended to disrupt the clot. Unfortunately, the actual mechanism of action of this therapy remains unclear...
Conclusion: Why does ultrasound-assisted CDT work?


Understanding why ultrasound-assisted CDT works seems like peeling away layers of an onion, with each layer bringing us closer to the truth. The outer-most layer is ultrasonic energy, which isn’t supported by the only RCT testing it. The next layer is CDT without ultrasound, which likewise was ineffective in the only RCT testing it. Its theoretical basis is also questionable. Ultimately, we are only left with the systemic effects of quarter-dose alteplase, which has proven efficacy and probably is the main mechanism behind all of these therapies.
Mechanism of action matters. For example, the PERFECT study concluded that ultrasonic energy was expensive and nonbeneficial, so CDT without ultrasound should be used. If CDT without ultrasound were also unnecessary, this would imply that similar benefits could be obtained with a slow peripheral infusion of quarter-dose alteplase. Administering alteplase peripherally could allow thrombolysis to be started sooner, achieved noninvasively, and be widely utilized in any hospital."